This key note speech at the SemeAd Conference (Sao Paulo, Brazil) on November 9, 2017 addresses the topic of management innovation in healthcare organizations. The Need for management innovation - understood as a reflexive communicative practice to step back from the ongoing organizing flow - arises due to environmental pressures and internal organizational complexity. Illustrated with a current research project on lean management at an Emergency Care Unit, the talk argues that management innovation follows a self-referential process rather than a linear one often found in current literature. To handle the challenge of self-referentially innovating the unit's own management practice, reflexivity is a key component. This leads to the insight that establishing reflexivity in the organization is a core task of management to enable its own change. The presentation concludes with methodological implications for studying management innovation as reflexivity with reflexive means.